The Impact on Management and Outcomes of Benign and High-Risk Breast Lesions after the Introduction of Vacuum Assisted Excision

Objective: Previous studies have shown that vacuum-assisted excision (VAE) is a safe , effective alterna-tive for surgical excision (SE) of benign breast lesions. However, the use of VAE in high -risk lesions is controver-sial and guidelines are ambiguous. This study describes the impact of the implementation of VAE in terms of management and outcomes compared to a cohort before implementation.Methods: A single centre retrospective study with two cohorts: 'before' and 'after' implementation of VAE was performed. All patients with a benign or high -risk lesion treated by VAE or SE between 2016 and 2019 were included. Excision, complication , upgrade rates were compared between both cohorts. Cox regression was used for the evaluation of recurrences and re-excisions.Results: The overall excision rate of all benign and high -risk lesions was comparable in both cohorts (17% vs 16%, p = 0.700). After implementation, benign lesions were significantly more often managed by VAE (101/151, 67%, p < 0.001). Re-excision, recurrence , complication rates were low , comparable between cohorts (4.3% vs 3.9%, p > 0.999; 3.0 vs 2.0%, p = 0.683; 3.4 vs 6.6%, p = 0.289, respectively).Conclusion: SE could safely be replaced by VAE in 58% of patients treated for a benign or high -risk lesion. With this shift in management, the use of operating rooms and general anaesthesia can safely be omitted in this patient group. Further research on high -risk lesions is warranted since our data are exploratory.Advances in knowledge: This study provides supportive data for the use of VAE as a management option for both benign (up to 5 cm) and high -risk lesions. Outcomes on re-excision, recurrence should be confirmed in prospec-tive studies especially in high -risk lesions.